Estimates of cost and effectiveness were obtained for aspirin, antihypertensive drugs, statins and clopidogrel. Cost per coronary event was calculated for treatments individually and in combination for patients at various levels of risk.
The most cost effective preventive treatments were aspirin and antihypertensive drugs, whereas simvastatin and clopidogrel were the least cost effective.
For instance, cost per coronary event prevented in a patient at 10% risk over five years was £3,500 for aspirin, £12,500 for initial antihypertensives, £18,300 for intensive antihypertensives, £60,000 for clopidogrel, and £61,400 for simvastatin.
These results cast doubt on present policy, says the author. A more efficient prevention strategy would be to offer most men over 55 and most women over 65 aspirin than to give statins to a few high-risk patients.